The need to prevent venous thromboembolism (VTE) following blunt solid organ injury must be balanced against the concern for exacerbation of hemorrhage. The optimal timing for initiation of VTE chemoprophylaxis is not known. The objective was to determine the safety and efficacy of early (≤48 hours) VTE chemoprophylaxis initiation following blunt solid organ injury.METHODS: An electronic search was performed of medical libraries for English-language studies on timing of VTE chemoprophylaxis initiation following blunt solid organ injury published from inception to April 2020. Included studies compared early (≤48 hours) versus late (>48 hours) initiation of VTE chemoprophylaxis in adults with blunt splenic, liver and/or kidney injury.Estimates were pooled using random-effects meta-analysis. Odds ratios were utilized to quantify differences in failure of nonoperative management, need for blood transfusion and rates of VTE. RESULTS:The search identified 2,111 studies. Of these, ten studies comprising 14,675 patients were included. All studies were non-randomized and only one was prospective. The overall odds of failure of nonoperative management were no different between early and late groups, OR 1.09 (95%CI 0.92-1.29). Similarly, there was no difference in the need for blood transfusion either during overall hospital stay, OR 0.91 (95%CI 0.70-1.18), or post prophylaxis initiation, OR 1.23 (95%CI 0.55-2.73). There were significantly lower odds of VTE when patients received early VTE chemoprophylaxis, OR 0.51 (95%CI 0.33-0.81). CONCLUSIONS: Patients undergoing nonoperative management for blunt solid organ injury can be safely and effectively prescribed early VTE chemoprophylaxis. This results in significantly lower VTE rates without demonstrable harm.

Fixed multiplane deformities around the hip representing a combination of rotational, angular, and leg-length discrepancies are disabling for the patient and pose a challenge for the orthopaedic surgeon. We describe a joint-preserving, one-stage procedure to address these complex problems using an intertrochanteric osteotomy with a step-cut to allow for corrective lengthening, angulation, and rotation. We present our results in nine patients. The aim of this paper is to provide the orthopaedic surgeon with a detailed approach to treating these deformities with reproducible results.Résumé Les déformations fixées fixées au niveau de la hanche, interessant plusieurs plans avec une composante de modification de longueur sont invalidantes pour le patient et posent de difficiles problèmes au chirurgien. Nous décrivons une technique d'ostéotomie intertrochantérienne en un temps avec correction des angulations, des rotations et des différences de longueur. Nous présentons nos résultats chez neuf patients. Le but de cette présentation est de fournir une approche détaillée au chirurgien orthopédiste pour traiter ces déformations avec des résultats reproductibles.

Background and Hypothesis:  Component loosening and instability are the leading causes of revision total hip arthroplasty (THA). The purpose of this study was to compare patient-reported outcomes after revision THA based on failure etiology. We hypothesized that outcomes would differ based on reason for revision. Project Methods: 187 consecutive revision THAs performed between 2010 and 2017 were retrospectively reviewed. Prospectively collected preoperative and minimum one-year Hip Disability and Osteoarthritis Outcome Score/HOOS Jr., UCLA Activity Level, WOMAC Index, and patient satisfaction were assessed based on failure etiology.  Demographic variables and covariates were accounted for including sex, age, BMI, ASA classification, heart disease, lumbar spine pathology, narcotic use, fibromyalgia, depression, and autoimmune arthritis.   Results: Latest UCLA activity level did not differ based on failure etiology (p=0.381). However, the degree of improvement in activity level was higher (p= 0.04) in patients revised for loosening, instability, and infection compared to ALTR and polyethylene wear. HOOS Jr (p=0.949) and WOMAC total (p=0.147) scores did not differ based on failure etiology at latest follow-up, although patients revised for loosening had greater WOMAC improvement compared to all other groups except polyethylene wear (p=0.016). Satisfaction did not vary based on failure etiology (p=0.365), and demographic and covariates were unrelated to outcomes (p[Symbol]0.165).    Conclusion and Potential Impact: We observed that patient-reported outcomes following revision THA vary based on revision reason and activity level improvement is mitigated patients revised for ALTR and poly wear.  These findings may help surgeons and patients alike set expectations for recovery following revision THA.